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The pros and cons of reverse total shoulder replacement

When you’re about to undergo an important surgery like joint replacement, hearing about the complication rate is rarely comforting news. Even if the rate is low, will it matter if you’re one of the rare cases where things don’t go as planned? And, if surgery is your only option to address chronic pain or loss of function, will knowing that change your decision?

Probably not—especially for patients with a deficient rotator cuff who may suffer significant pain for long periods before opting for a relatively new treatment—reverse total shoulder replacement. The procedure is aptly named because it reverses the anatomy of a shoulder by replacing the socket side of the shoulder with a ball and the ball side with a socket. “It can really help restore movement, especially when lifting the arm up over the head,” said Marshall L. Trusler, MD, an orthopedic sports medicine physician at Indiana University Health Ball Memorial Hospital.

Despite good results for certain older patients, the procedure is often a choice of last resort due to possible complications. It’s important that reverse shoulder replacement candidates go into the procedure with a clear idea about the risks. Among them are dislocation, nerve/blood vessel damage, wound hematomas and loosening of the prosthesis caused when the scapula (shoulder blade) notches the surface.

“There are many possible reasons for instability and dislocation after a reverse total shoulder replacement,” Trusler says. “Your surgeon can identify the reason and make treatment recommendations.” If a replaced joint becomes chronically unstable, surgeons can sometimes revise the original procedure by replacing or changing the components of the reverse replacement.

In a small number of cases, however, the only answer is to remove the prosthesis or convert the joint replacement to replace half of the shoulder joint in a surgery called hemi-arthroplasty. That may solve the problem of instability, but it often results in significant loss of shoulder function—one of the possible risks of this increasingly common procedure.